Government, insurers to tackle health care fraud

The government is stepping up efforts to tackle health care fraud by scrutinizing claims data from insurers and federal programs in hopes of weeding out bogus billing.

Details of the initiative were to be announced Thursday at the White House by Health and Human Services Secretary Kathleen Sebelius, Attorney General Eric Holder, and insurance executives.

The analysis of data from Medicare, Medicaid and private health plans will look for suspicious patterns and other evidence that might indicate fraud, White House officials said. A “trusted third party” would comb through the data and turn questionable billing over to insurers or federal investigators.

He routinely criticizes insurance companies in campaign events. Yet he relied heavily on industry support to pass his landmark health overhaul and resisted calls from within his own party to set up a “single payer” plan of government-run insurance.

Officials said those who submit fraudulent claims often do so for both government programs and private insurance plans. Separately, such claims might not raise suspicions, but taken together they could raise a red flag, such as when a doctor bills for more than 24 hours in a day.

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In addition to out-and-out fraud, there is also the unnecessary testing, prescribing and repeat office visits that are generated by those providers of service who encourage insured individuals to use whatever their insurance plans – including Medicare – will pay for. Consumers are taking a double hit, both as taxpayers and premium-payers, for this “give ‘em anything that’s billable” attitude for which the costs must be astronomical.